Eligibility requirements for both MAGI and Non-MAGI applicants remain the same. However, the application procedures for Non-MAGI Medicaid and program requirements have been modified under COVID-19.
If you are a Benefits Plus subscriber, for additional information on Medicaid, refer to Benefits Plus, Health Programs, Medicaid. For subscription information visit: https://bplc.cssny.org/home/subscription_options.
No Cost Sharing for COVID-19 Testing & Treatment
Medicaid must cover, without any cost-sharing expenses, the following: COVID-19 testing, testing-related services, and COVID-19 related treatment for Medicaid enrollees, which include vaccines, specialized equipment and therapies.
Changes in Non-MAGI Application Procedures
WHO ARE NON-MAGI MEDICAID APPLICANTS
The following individuals are classified as non-MAGI Medicaid
- Individuals 65 or over;
- Disabled individuals with Medicare;
- Blind individuals with Medicare.
There is an exception, an individual/couple who is aged, disabled or blind with Medicare who is a parent or caretaker relative with children under 19 or who is pregnant may be classified as MAGI Medicaid.
To learn more about non-MAGI vs. MAGI Medicaid, refer to Benefits Plus, Health Programs, Medicaid, MAGI Medicaid vs. Non-MAGI Medicaid.
Closure of Local Medicaid Offices
Many local Medicaid offices are closed for in-person assistance. However, in NYC, one office remains open in each borough for in-person emergencies. To find open locations, visit: https://www1.nyc.gov/site/hra/locations/medicaid-locations.page.
The Medicaid application is the DOH-4220, Access NY Health Care and the DOH-5178A, Supplement A. Supplement A is used when applying for Community Based Long Term Care Services or Institutional Medicaid. If applying for Community Based Medicaid, Supplement A is not required.
- DOH-4220: https://www.health.ny.gov/forms/doh-4220.pdf
- Supplement A: https://www.health.ny.gov/forms/doh-5178a.pdf
- Spanish DOH – 4220: https://www.health.ny.gov/forms/doh-4220_es.pdf
Submitting an Application Via Fax
During the COVID-19 emergency, non-MAGI Medicaid applicants are able to submit a Medicaid application via fax to 917-639-0732. In addition, young adults under age 26 who were formerly in foster care may submit an application via fax.
Individuals who have an immediate need for home care, can fax their application and home care request to 917-639-0665.
Submitting an Application via Facilitated Enrollers
Non-MAGI Medicaid applicants may also contact a facilitated enroller (FE) to apply for Medicaid via telephone. The FE, community-based organizations contracted by NYS to assist the aged, blind and disabled population with application/ recertification assistance, must send the individual a copy of the Medicaid application to use during the required telephone interview, as well as the DOH form 5147, Submission of Application on Behalf of Applicant, which allows the FE to sign the application on the applicant’s behalf. Both these forms can be sent by standard mail or by email, if acceptable to the applicant.
The applicant must sign and return both documents prior to conducting the interview. The form can be scanned and emailed back to the FE ABD agency.
Applicants can attest to all elements of eligibility except immigration status and identity, if the immigration document does not also prove identity, see below, Documentation.
The following agencies serve as facilitated enrollers in NYS:
- Community Service Society – 888- 614-5400 https://www.cssny.org/programs/entry/facilitated-enrollment-for-the-aged-blind-and-disabled-program-fe-abd
- Public Health Solutions – 646-619-6759
- Nassau/Suffolk Hospital Council – 631-656-9783
- Western New York Independent Living – 716-836-0822 ext. 130
During the COVID-19 emergency, if an applicant has missing information, their local district will attempt to contact them via phone or e-mail (the district does not need to receive the information in writing and can accept information verbally).
If the local district is unable to contact the individual, the local district will send a written request for the missing information with a due date of no less than 10 days.
Local districts must allow for self-attestation for all eligibility criteria, except for immigration status and identity, if the immigration document does not also prove identity. Applicants that need to prove immigration status/identity should submit the required copies of documentation. However, if an applicant is not able to submit documentation due to the COVID-19 emergency, the application should still be submitted and processed. Applicants will be granted a 90-day reasonable opportunity to provide the required documents. If the COVID-19 emergency has not ended and supporting documents have not been received at the end of the reasonable opportunity period, coverage should be extended for a second 90-day period.
Applicants whose citizenship status is not verified through data sources will be given an opportunity to submit documents later.
Self-Attestation for Nursing Home Level of Care
In addition, individuals applying for Medicaid coverage of nursing home care can attest to income and resources during this emergency, including attesting to any transfer of assets in the look-back period.
The use of the Asset Verification System (AVS) provides the agency with bank account and real property information. Documentation is only required when information is not available in AVS or for incapacitated individuals that cannot consent to AVS.
Individuals in need of a disability determination, for example to establish a supplemental needs trust, should contact their local district to assist with the necessary documentation to process the disability determination.
CONDITION OF ELIGIBILITY REQUIREMENTS
Application for Other Benefits
During the COVID-19 emergency, applicants will not be required to apply for Medicare, Social Security; in addition, referrals for Veterans benefits have been suspended. This requirement is waived for the period of the COVID-19 emergency.
Applicants with an absent parent must not be referred to child support and will not be required to comply with child support requirements as a condition of Medicaid eligibility.
Third Party Health Insurance
Applicants will not be required to provide third party health insurance information and local districts are not required to make new cost-effective determinations for possible reimbursement.
If a signature on the Access NY Application and/or Supplement A cannot be signed by the applicant (or the applicant’s spouse) and the applicant is in a hospital or nursing home, the application can be signed by someone acting on behalf of the individual. The individual who is signing on behalf of the application must complete Submission of Application on Behalf of Applicant (DOH-5147 for NYS (http://coverage4healthcare.org/insurance_over_65/authorized_representative.pdf); MAP3044 for NYC) and must note the applicant cannot sign the form due to access issues/COVID-19 emergency.
If the applicant can sign the application, then the applicant must sign the DOH-5147 him/herself to authorize another person or the facility to apply on behalf of the individual.
MAGI Medicaid includes the following population groups:
- Pregnant women;
- Dependent children under the age of 19;
- Parents/caretaker relatives of children under 19;
- Applicants 65 and over, as well as applicants with Medicare, are typically budgeted as non-MAGI.
- However, if such an applicant is a parent/caretaker relative with children under 19, s/he may choose to be classified as MAGI and MAGI budgeting rules and application and renewal procedures would apply.
- Singles/Childless couples ages 19 through 64 who are not entitled to or enrolled in Medicare.
- This includes SSDI beneficiaries who do not yet have Medicare
These individuals continue to submit an application via the NY State of Health at https://nystateofhealth.ny.gov or by calling 1-855-355-5777, there is no change.
Changes in Medicaid Renewals
During the COVID-19 emergency beginning March 18, 2020, Medicaid cases will NOT be closed for failure to renew or for failure to provide documentation, unless the individual voluntarily cancels his/her Medicaid or moves out of NYS. All active Medicaid cases with authorization and coverage dates due to expire through December will be systemically extended by 12 months. This renewal extension applies to all renewal cases including Office of Mail Renewal, MLTC, Nursing Home Eligibility, Medicare Savings Program, MBI-WPD, individuals who lose their SSI eligibility or Cash Assistance.
This provision applies regardless of any changes in circumstances that would otherwise have resulted in coverage termination. Individuals do not need to take any action to keep their coverage. However, if an individual informs the district of a change that results in an increase in Medicaid coverage, the district is required to process the change.
Any case that is closed will be re-opened and coverage restored to ensure no gap in coverage. If a renewal, notice or other correspondence is returned to the district with no forwarding information, the district must maintain coverage for the case for the duration of this emergency.
The renewal extension applies to all renewal cases including Office of Mail Renewal, Managed Long Term Care, Nursing Home Eligibility, Medicare Savings Program, and Medicaid Buy-In for Working People with Disabilities.
MEDICAID SPENDDOWN CASES
Local districts should not increase an individual’s spenddown liability, as this is considered a reduction in coverage.
Individuals who met their spenddown in March will have their coverage extended for six months. Coverage will be extended for another 6 months if it would otherwise end during the COVID emergency.
Individuals who have a spenddown and have been unable to submit a bill or payment due to the COVID-19 emergency should contact their local district; in NYC they should call the MICSA Surplus Helpline at 929-221-0835. The individual should include the following information:
- Phone number
- If submitting a bill, provide the name of the provide, the date of the service, and the amount of the bill
- If submitting a payment, indicate the amount of the payment.
Clients will receive a call back if additional information is needed. If the requested information is provided, coverage will be extended for 6 months
CASH ASSISTANCE AND SSI CASES
SSI cash cases and any Cash Assistance/Medicaid cases that require a separate Medicaid eligibility determination will have their Medicaid coverage extended. No redeterminations are required at this time.
Changes in Program Requirements
CHILD SUPPORT REQUIREMENTS
Medicaid recipients will not be required to comply with child support requirements to apply for or maintain Medicaid coverage.
THIRD PARTY HEALTH INSURANCE
Individuals with third party health insurance will not be required to provide
information concerning available insurance.
Transition of Cases to and from NY State of Health
WMS TO NY STATE OF HEALTH
Effective April 2020, upstate transitions from WMS to NYSOH are suspended. For NYC, individuals who are transitioned to NYSOH but who do not gain Medicaid coverage through NYSOH will have their case re-opened on WMS.
NY STATE OF HEALTH TO WMS
The monthly referrals of WMS for those individuals turning 65 with an active Medicaid case on NYSOH were suspended as of March 19, 2020. However, referrals of those turning 65 to NYSOH may still be sent to local districts because another identifier triggered the transition to WMS.
MEDICAID MANAGED CARE ISSUES
Prior to the COVID-19 crisis, anyone with Medicare could not remain in a Mainstream Medicaid Managed care plan (MMC), HIV Special Needs Plan (SNP) or a Health and Recovery Plan (HARP). (All these plans cover most all long-term care services and supports.) Under the Families Firs Coronavirus Response Act, such individuals now have the following Medicaid options:
- Dually eligible members may stay in their Medicaid managed care plan (MMC, HIV SP or HARP) until the last day of the last month of the federal public health emergency ends; or
- Medicaid managed care plans will be responsible for coordinating benefits with Medicare for dually eligible members.
- NYSoH members who were enrolled in an MMC plan as of March 18, 2020 and who were systematically disenrolled to fee-for-service (FFS) Medicaid for April, May, June because they gained or attested to Medicare enrollment will be re-enrolled in the MMC plan effective July 1, 2020 and will receive an enrollment notice advising them of this change.
- Retrospective re-enrollment is permitted to the extent necessary to maintain continuous enrollment in their MMC plan during the COVID-19 crisis for individuals who were enrolled on March 18, 2020 and thereafter.
- Changes in the system ended the automatic disenrollment from the NY State of Health (NYSoH) Marketplace to fee-for-service Medicaid due to Medicare enrollment on May 28, 2020 for members newly eligible for Medicare.
- Dual-eligible members may enroll in traditional Medicare or a Medicare Advantage plan for their Medicare coverage while remaining in their MMC, HARP or HIV Special Needs Plan.
- Dually eligible members can move to regular, fee-for-service Medicaid (regular Medicaid), unless the member is in receipt of long-term care services and supports and is eligible to enroll in a Managed Long-Term Care Plan.
- If the dual eligible beneficiary needs personal care services, s/he can leave the MMC/HARP/HIV SNP.
- If they decide to leave the MMC/HARP/HIV SNP, and they are eligible for MLTC, the individual will enroll in an MLTC plan.
- If they leave, but are not eligible for MLTC, the individual can be covered by Fee-for-Service (FFS) Medicaid.
MMC plan dual-eligible members who are auto-enrolled in a Part D plan (due to deemed LIS) or who selected a Part D plan, should give all their plan cards to the pharmacy. However, in most cases the Part D plan will cover most pharmacy items.
Changes to Home Care Services
Home care recipients may want to temporarily reduce their current hours of home care or even pause their home care to limit their exposure to the coronavirus. The NYS Department of Health has issued a directive on April 23rd that states that home care recipients can make a temporary change to their care plan during the COVID-19 emergency by pausing or reducing the number of hours of home care. For more information visit: https://health.ny.gov/health_care/medicaid/covid19/docs/2020-04-23_guide_volplanofcare.pdf.
For additional information on Home Care cases visit: https://health.ny.gov/health_care/medicaid/covid19/docs/2020-03-18_guide_authorize_cb_lt_services.pdf.
Medicaid “Emergency Services Only” Coverage for Individuals without Documentation
NYS Medicaid coverage for individuals without documentation is limited to emergency services only. COVID-19 testing, evaluation, and treatment are emergency services and will be reimbursed by NYS Medicaid for individuals without documentation. There is no copayment for emergency services, including testing, evaluation and treatment for COVID-19.
During the COVID-19 emergency, consumers who requested a fair hearing with aid continuing status on or after March 18th, must be maintained with the same coverage during the period of the emergency.
How COVID-19 Cash Aid Impacts Medicaid
ECONOMIC IMPACT PAYMENTS
The CARES Act Economic Impact payments (EIP) (up to $1,200 per individual, $500 per qualifying child) will not count when determining eligibility for Medicaid. However, twelve months after receiving the benefit any remaining money will count as a resource when determining eligibility for Non-MAGI Medicaid applicants/ recipients.
PANDEMIC UNEMPLOYMENT COMPENSATION
The $600 per week in Pandemic Unemployment Compensation will not count when determining eligibility for Medicaid. However, twelve months after receiving the benefit any remaining money will count as a resource when determining eligibility for Non-MAGI Medicaid applicants/recipients. The base Unemployment Insurance benefit, including PUA, does count as unearned income.